Table Of ContentImmunology
of Endocrine
Diseases
IMMUNOLOGY AND MEDICINE SERIES
Immunology of Endocrine Diseases
Editor: A. M. McGregor
Clinical Transplanation: Current Practice and Future Prospects
Editor: G. R. D. Catto
Complement in Health and Disease
Editor: K. Whaley
Immunology of Oral Diseases
Editor: L. Ivanyi
Immunoglobulins in Health and Disease
Editor: M. A. H. French
Immunology of Malignant Diseases
Editors: V. S. Byers and R. W. Baldwin
Lymphoproliferative Diseases
Editors: D. B. Jones and D. Wright
HLA and Disease
Authors: B. Bradley, P. T. Klouda, J. Bidwell and G. Laundy
Lymphocytes in Health and Disease
Editors: G. Janossy and P. L. AmIot
Mast Cells, Mediators and Disease
Editor: S. T. Holgate
IMMUNOLOGY __
-'.S =ER=IES=-·=SE=RIE::-S. SERIES· SERIES AND SERIES· SERIES· SERIES· SERIES·
MEDICINE
ImmunolQgy
of Endocrine
Diseases
Edited by
Alan M. McGregor
Senior Lecturer and Honorary Consultant Physician,
Department of Medicine, University of Wales College of Medicine,
Heath Park, Cardiff
Series Editor: Professor W. G. Reeves
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M.TP PRESS LIM.ITED
:.l"~ a memberof the KLUWER ACADEMIC PUBLISHERS GROUP ,_
LANCASTER / BOSTON / THE HAGUE / DORDRECHT '1IIIIIIII-
Published in UK and Europe by
MTP Press Limited
Falcon House
Lancaster, England
British Library Cataloguing in Publication Data
Immunology of endocrine diseases. -
(Immunology and medicine series)
I. Endocrine glands - Diseases -
Immunological aspects
I. McGregor, A. M. II. Series
616.4'079 RC649
ISBN-13: 978-94-010-8352-2 e-ISBN -13: 978-94-009-4171-7
DOl: 10.1007/978-94-009-4171-7
Published in the USA by
MTP Press
A division of Kluwer Academic Publishers
10 I Philip Drive
Norwell, MA 02061, USA
Library of Congress Cataloging-in-Publication Data
Immunology of endocrine diseases.
(Immunology and medicine series)
Includes bibliographies and index.
I. Endocrine glands - Diseases - Immunological
aspects. I. McGregor, A. M. (Alan M.), 1948-
II. Series. [DNLM: I. Autoimmune Diseases.
2. Endocrine Diseases - Immunology. WK 100 133]
RC649.I46 1986 616.4'079 86-14381
ISBN-13: 978-94-010-8352-2
Copyright © 1986 MTP Press Limited
Softcover reprint of the hardcover 1st edition 1986
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without prior permission
from the publishers.
Typset by Witwell Ltd., Liverpool.
Contents
Preface VII
Series Editor's Note ix
List of Contributors xi
The mouse model of autoimmune thyroid disease
Y. M. Kong
2 Recent developments in the in vitro bioassay of TSH and
thyroid-stimulating antibodies 25
N. J. Marshall and P. A. Ealey
3 Immunoglobulins affecting thyroid growth 51
H. A. Drexhage and R. D. van der Gaag
4 Islet cell antibodies 73
S. Baekkeskov. M. Christie and A. Lernmark
5 Insulin antibodies 89
A. Kurtz
6 Immunogenetics of diabetes 103
A. H. Barnett
7 Immunogenetics of Graves' disease 123
H. Tamai. L. F. Kumagai and S. Nagataki
8 HLA-DR antigen expression and autoimmunity 143
A. P. Weetman
9 Observations on Graves' ophthalmopathy; pathology and pathogenesis 161
R. M. Pope. M. E. Ludgate and A. M. McGregor
10 Autoimmune thyroid disease in pregnancy and the postpartum period 181
R. Jansson and A. Karlsson
In~x I~
This book is dedicated to:
Duncan D. Adams
Deborah Doniach
Ivan M. Roitt
Noel R. Rose
whose publications 30 years ago in 1956,
and contributions since have shaped our
understanding of the organ-specific,
autoimmune endocrine diseases.
Preface
Nineteen eighty-six is a most appropriate year in which to be writing about
developments in the organ-specific, autoimmune endocrine diseases. It
celebrates the publication 30 years ago in 1956 of the classic papers of Roitt
and Doniach and their co-workers I , and of Rose and Witebsky2 and Adams
and Purves3.
These three sets of fundamental observations provided the initial building
blocks upon which much of what has been established in the field in the last
30 years was built.
No publication of this nature on endocrine autoimmune disease can cover
every aspect of the subject. I have chosen to highlight the organs (thyroid and
pancreeas) which have attracted the most attention, and the areas of work
within these fields within which most research effort is currently focused.
There are still some gaps; the insulin and TSH receptors are not considered,
nor in any detail are the role of cytotoxic mechanisms in mediating gland
destruction. Molecular biology will undoubtedly in the next few years clarify
once and for all the controversy that surrounds the structure of the TSH
receptor and T cell cloning, the role of cell-mediated cytotoxicity. The
pathogenetic mechanisms underlying autoimmunity are increasingly well
understood and the search for the aetiology has begun. In this context, the
role of the immune system itself (and abnormalities within it) in the develop
ment of autoimmunity is still unresolved; is their an organ-specific suppressor
T cell defect?4, what of epithelial cell HLA-DR expression?5, what of the
anti-idiotypic antibody?6. The role too ofthe environment in the development
of autoimmune disease likewise remains uncertain. Can iodine be implicated
in the development of thyroid disease?7 and what of infectious agents causing
disease in genetically-predisposed individuals?8. All these are questions for the
future.
In this monograph, I have chosen to highlight areas which have been
associated with important developments or are areas of considerable current
interest. The authors selected are currently working in these areas and their
contributions enhance our understanding of their field of expertise.
Alan M. McGregor
Cardiff, May 1986
References
I. Roitt, I. M., Doniach, D., Campbell, P. M. and Hudson, R. V. (1956). Autoantibodies in
Hashimoto's disease (lymphadenoid goitre). Lancet, 2, 820-1
vii
IMMUNOLOGY OF ENDOCRINE DISEASES
2. Rose, N. R. and Witebsky, E. (1956). Changes in the thyroid glands of rabbits following
active immunisation with rabbit thyroid extracts. J. Immunol. 76,417-27
3. Adams, D. D. and Purves, H. D. (1956). Abnormal response in the assay for thyrotrophin.
Proc. Univ. Otago Med. Sch., 34, 11-12
4. Volpe, R. (1981). Autoimmunity in the endocrine system. Monographs in Endocrinology,
10,1-187
5. Bottazzo, G. F., Pujol-Borrell, R., Hanafusa, T. and Feldman, M. (1983). Role of aberrant
HLA-DR expression and antigen presentation in the induction of endocrine autoimmunity.
Lancet, 2, 1115-18
6. Cooke, A., Lydyard, P. M. and Roitt, I. M. (1983). Mechanisms of autoimmunity: a role
for cross-reactive idiotypes. Immunology Today, 4, 170-5
7. Hall, R. and Kobberling, J. (1985). Thyroid disorders associated with iodine deficiency and
excess. Serono Symposia Publication Volume 22. (New York: Raven Press)
8. Onodera, T., Tonionlo, A., Ray, U. R., Jenson, A. B., Knazek, R. A. and Notkins, A. L.
(1981). Virus-induced diabetes mellitus xx. Polyendocrinopathy and autoimmunity. J.
Exp. Med., 153, 1457-73
viii
Series Editor's Note
The modern clinician is expected to be the fount of all wisdom concerning
conventional diagnosis and management relevant to his sphere of practice. In
addition, he or she has the daunting task of comprehending and keeping pace
with advances in basic science relevant to the pathogenesis of disease and
ways in which these processes can be regulated or prevented. Immunology has
grown from the era of anti-toxins and serum sickness to a state where the
study of many diverse cells and molecules has become integrated into a
coherent scientific discipline with major implications for many common and
crippling diseases prevalent throughout the world.
Many of today's practitioners received little or no specific training in
immunology and what was taught is very likely to have been overtaken by
subsequent developments. This series of titles on IMMUNOLOGY AND
MEDICINE is designed to rectify this deficiency in the form of distilled
packages of information which the busy clinician, pathologist or other health
care professional will be able to open and enjoy.
Professor W. G. Reeves, FRCP, FRCPath
Department of Immunology
s
University Hospital, Queen Medical Centre
Nottingham
ix
List of Contributors
S.BAEKKESKOV R. D. VAN DER GAAG
Hagedorn Research Laboratory Laboratory for Clinical Immunology
Niels Steensensvej 6 Department of Pathology
OK 2820 Gentofte Free University Hospital
DENMARK De Boelelaan 1117
1081 HV Amsterdam
THE NETHERLANDS
A. H. BARNETT
Department of Medicine R.JANSSON
University of Birmingham and Department of Internal Medicine
East Birmingham Hospital University Hospital
C/O East Birmingham Hospital University of Uppsala
Bordesley Green East S-751 85 Uppsala
Birmingham B95ST SWEDEN
UK
A. KARLSSON
Department of Internal Medicine
M.CHRISTIE University Hospital
Hagedorn Research Laboratory S-751 85 Uppsala
Niels Steensensvej 6 SWEDEN
DK 2820 Gentofte
DENMARK
Y. M. KONG
Department of Immunology and
Microbiology
H. A. DREXHAGE Wayne State University
Laboratory for Clinical Immunology School of Medicine
Department of Pathology 540 East Canfield Avenue
Free University Hospital Detroit
De Boelelaan 1117 MI 48201
1081 HV Amsterdam USA
THE NETHERLANDS
L. F. KUMAGAI
Department of Internal Medicine
P.A.EALEY Division of Endocrinology
Department of Chemical Pathology University of California
University College Hospital Davis
Gower Street 4301 X Street
London WC1 E 6AU Building Folb II-C
UK Sacramanto, CA 95817, USA
xi
